WHY DOES MY SHOULDER HURT SO MUCH?

This is going to be a bit of a long one, so buckle up, people!

So, what exactly occurred when I had the heart attack? This post will be the first in a few that will describe the events, some of the medical details, and how I and some others reacted to the whole shemozzle.

I was at the cottage with my wife, Jenny, and five of our friends from all around North America. They were mostly my wife's former colleagues, visiting to enjoy a weekend away. We had arrived on Friday afternoon, and I spent most of Saturday doing chores. There was quite a bit of lifting and carrying, including a large cinderblock that had to be chucked out into the river as an anchor for a floating platform. On Sunday morning, I woke up feeling mostly okay, but with a touch of soreness in my left shoulder.

The Cottage

But maybe we should rewind about ten days to an injury I suffered while playing softball. I know it's not exactly the highest impact sport, but even in softball you can strain yourself in a number of ways. My situation involved reaching for an errant throw at first base. I don't even remember if I made the play, but, I probably didn't scoop it. Unfortunately, a joint injury doesn't particularly care whether or not you're successful in your athletic endeavours.

But maybe we should rewind about ten years to the first time I injured my shoulders in any significant manner. Back in the winter of 2014, shortly after Jenny and I moved in together, I had a bout of severe left shoulder pain due to inflammation of the articular capsule. I could barely lift my arm to 45 degrees, which resulted in me relying on my right shoulder way too much for lifting things and whatnot. That eventually resulted in similar pain in my right shoulder. I attended physiotherapy, which helped a lot, but the eventual diagnosis from the doctor was that it may have been a bacterial infection the whole time. Obviously, correlation isn't causation, but within about a week of starting a course of antibiotics, I started to get better. The problem I now have is that almost every winter season the shoulder pain comes back, though it has been getting better each year. So, long story short, there's a history of shoulder bullshit.

But maybe we should rewind even farther and talk about general health and diet? I definitely wouldn't put myself in the top level of healthy, athletic folks. That said, I also wouldn't consider myself to be entirely bereft of moderation in exercise and diet. I play the aforementioned softball every week in the summer. I was a regular sport climber (mostly top rope). And of course there was the occasional hikes and whatnot. As for food, admittedly, I pretty much ate whatever I wanted. I'm definitely a bit of a foodie, and had no trouble enjoying some of my favourite foods like steak, pizza, sushi, and potato chips. I wouldn't say I was gluttonous, but, I also was, quite frankly, not taking care of myself. Prior to the heart attack, I was 5'10" and 230 pounds. I in no way wish to body shame myself or anyone else, but, from a perspective of mitigating health risks, this was a less than optimal situation.

I’m not sure this is scientifically accurate

But maybe we should rewind even farther and talk about genetics. I fully accept that I wasn't taking care of myself as well as I should have, and that was likely a factor in the heart attack taking place. But, as I have had made clear to me by numerous health experts, the most relevant factor is genetics. For whatever reason, somewhere along the line in my genetic soup (stew? chowder?) I acquired the inability to effectively block atheromatous plaque from forming in my arteries. As I know some of my family members might read this, let me be clear, I in no way, shape, or form "blame" my genetic forebearers for this. By way of hopefully helping others who are concerned about their genetics, or about what they might "pass down" to their successors, all I can say is that we're all "dealt a hand" that we have to play. There's no help in placing blame on something over which you have zero control. Perhaps I'll tackle this topic a bit more in future.

So, there I was, laying in bed on a Sunday morning with a minor amount of left shoulder pain. This wasn't entirely unusual, and almost always cleared up after getting out of bed, stretching, and getting on with my day. Maybe I had tweaked that previous softball injury? Maybe I just slept on it funny? Maybe tiny gremlins were in there mining bone marrow from my clavicle? I completed my morning ablutions and drove the ten minutes into town to pickup a few items for brunch and the dinner I was going to cook that evening.

When I returned, the shoulder pain started to get worse. Within a few hours it was spiking into a shooting pain and a dull ache that was spreading down my left arm and a little bit into my chest area. It felt extremely similar to all my previous shoulder injuries, so, at first, I did not give it much thought. By four in the afternoon I was starting to get more concerned. The pain wasn't getting too much worse, per se, but it was definitely causing me more concern. Partway through preparing dinner (ribeye steak; giant, portobello mushrooms; a couple big salads) I ended up having to go lay down because the pain was becoming quite uncomfortable. I asked some of our guests to take over and retired to the bedroom to get some rest.

At its most acute, it was a completely unique experience, rotating between a 7 out of 10 pain in my shoulder, neck, arm, chest, and even my belly, and feeling absolutely no pain whatsoever. Later, I was told this was probably unstable angina, exacerbated by a small injury to the artery that would repeatedly tear and heal. During the tearing, blood flow was restricted, and I'd be in pain; but, once the artery had healed a little, and blood flow returned, the pain would abate. By about 8:30PM, I had decided that the pain was too much.

Dear reader, let me take a little detour here and talk about what went on in my head. Did I think it was definitely just recurring shoulder pain? No, I had my doubts. But, I pretty adamantly didn't want it to be more than just shoulder pain. I was fully aware that, even at 46 years old, I could be having a heart attack or a stroke, or something more serious than Chris' poor shouldie huwting. During this painful back and forth, I had been texting with my friend, Jamie, an emergency physician who had always been so generous with her time and advice. She counseled me to get to the hospital if the pain went past a certain point, and I was pretty adamantly going to follow that guidance. My Apple Watch, consistently informing me that it was not capable of faithfully diagnosing a heart attack, did its paltry single-lead EKG and persistently returned a "sinus rhythm" notification. I genuinely believe I was getting somewhat conflicting feedback on what my next course of action ought to be.

My Apple Watch EKG from 2024-08-04 @ 7:58PM. Check out the tiny blip just after the main spike. More on this, and ST-Elevated Myocardial Infarctions in a later post

So, there I was, laying down, hoping beyond hope that this wasn't serious. Was this a tremendously stupid thought process? Yes! Do I know better now? Yes. However, and let me be extremely clear about this, after you have a heart attack you are acutely aware of every pain and twinge and spasm and ache and pang in your body and you can become a bit paranoid that each of these instances is the beginning of the end. Think of Red Foxx in Sanford and Son. So, while I'll be a lot smarter about calling an ambulance in the future, there is a type of coronary calculus that is a part of my daily life.

Redd Foxx was hilarious

At this point I was sure that this was too much pain for me, regardless if it was some sort of a ligament tear or a cardiovascular event. The time was well past when I should see a medical professional. At that moment, I assumed it would be quicker to get help by driving to the hospital. Not me driving the actual car; I'm not that completely obtuse, but taking a car to get there. I understood that an ambulance could probably reach me before I could get to the hospital myself, I didn't consider that the ambulance comes with a whole bunch of stuff in it that can keep a person alive. Was this also pretty stupid thought process? Yes. But maybe you don't think entirely clearly when you're in that much pain. Not to put a too fine point on it, if you think you're having a heart attack, call a fucking ambulance! You might be able to get to a hospital by yourself sooner than an ambulance can get to you and get you to the hospital, but they can save your life along the way.

Either way, Jenny and I hopped in the car and made our way to Haliburton Highlands Hospital. It's about a 38 minute drive if you're being a good boy, but let's just say it did not take that long. While in the car, the pain began to increase, and, for the first time that day, I started having trouble breathing. We pulled up to the emergency entrance, and I walked inside while Jenny parked. There were only three people waiting in the emergency lobby. There was no staff sitting at the check-in kiosks, but a sign said to knock on the door to a back area if there was an emergency. Perhaps it's the stereotypical Canadian politeness, or maybe I'm just a fucking idiot, but I asked the patient closest to the check-in area if there was a lineup to be treated. He looked up at me, and, I think seeing my state [I'm already a white dude (like really, really white), but apparently my skin colour so pallid and alabaster it was alarming everyone], and told me that I ought to knock on the door and get immediate assistance. I followed his advice and a nurse appeared.

The people in this building saved my life

"I think I'm having a heart attack," I offered feebly. She sat me down and did an initial assessment and called for a gurney. They brought me into an emergency room. All told, I'd say maybe ninety seconds went by between walking in the door and being surrounded by a team of emergency professionals. In a subsequent blog post I'll talk about the absolutely incredible people that saved my life that day; but, in short, Dr. Costea and her team were calm, professional, and precise. I could tell from their demeanor that they were taking this very seriously and that there was potential for significant harm. They hooked me up to a six lead EKG, setup an IV line, and took a bunch of blood. There was a lot of medical talk I didn't understand, poking and prodding, and after about ten minutes or so, the doctor left the room to look at test results.

When she returned, I experienced one of the most contradictory moments of my life. As she walked in, I could tell that her disposition had changed. She was still very professional, but, it was clear that questions had been answered, and the acute seriousness of the event had somewhat passed. This was extremely calming, and I appreciated it greatly. She also provided a diagnosis of "so...you had a heart attack." I should be careful here and point out that, though this was an extremely contradictory moment, it wasn't jarring or unpleasant. I guess I could paraphrase it as "yes, one of the worst things that can happen to you is happening to you right in this very instant, but it's under control and we're going to do everything we can to stabilize you." There was also some specifically good technical news. She reported that my troponin levels (in this context, the protein that can indicate severity of heart injury during a coronary event) were only slightly elevated. Obviously, this was still a serious medical event, but, as far as how serious a heart attack can be, this was on the lower end.

WHAT'S NEXT? Our story that takes us to Peterborough and the land of cardiac catheterization!